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Small bowel obstruction due to Abdominal Adhesions


A 35 year old male presented with abdominal pain, cramping, abdominal distension and multiple episodes of vomiting. X ray revealed dilated small bowel loops with multiple air fluid levels. The vitals of patient were stable and showed no signs of strangulation. The patient was initially managed conservatively with analgesia, intravenous fluids, nasogastric suction and an indwelling urinary catheter. But even after a day of conservative therapy the symptoms were not relieved and an exploratory laprotomy was done to reveal a dense adhesion kinking the small bowel around its axis.


Abdominal Adhesions: Important Points
  1. Opening the peritoneal cavity, in whatever type of surgery, leads to the formation of potentially obstructive structures (adhesions or bands) in almost 95% of patients.[1]
  2. Today, with the increased incidence of abdominal surgery, these structures are the most frequent cause of small bowel obstruction (SBO)- almost over two third cases of SBO caused by adhesions.[2]
  3. Although most adhesions cause no symptoms or problems, others cause chronic abdominal or pelvic pain. Adhesions are also a major cause of intestinal obstruction and female infertility.
  4. Abdominal Adhesions and Female Infertility: Abdominal adhesions can lead to female infertility by preventing fertilized ova from reaching the uterus. Women with abdominal adhesions in or around their fallopian tubes have an increased chance of ectopic pregnancy.

References
1] Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study.
Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, McGuire A, Lower AM, Hawthorn RJ, O'Brien F, Buchan S, Crowe AM
Lancet. 1999 May 1; 353(9163):1476-80.
2]Miller G, Boman J, Shrier I, et al. Etiology of small bowel obstruction. Am J Surg. 2000;180:33–36





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